Vol. 9, Issue 4, Part A (2025)

Clubfoot, or congenital talipes equinovarus, is one of the most common congenital musculoskeletal deformities, with an estimated global incidence of one to two per 1, 000 live births. Early diagnosis and initiation of treatment during infancy are critical for achieving optimal functional outcomes. However, in many rural and resource-limited settings, children with clubfoot frequently present late to healthcare facilities, often after the walking age, leading to increased severity of deformity and treatment complexity. Delayed presentation is influenced by multiple interrelated factors, including limited access to specialized orthopaedic services, low awareness among caregivers, sociocultural beliefs, financial constraints, and inadequate referral systems. These challenges significantly compromise the effectiveness of standard conservative management approaches and increase the likelihood of residual deformities, disability, and social stigma. Despite these obstacles, basic management strategies remain effective when appropriately adapted to rural contexts. The Ponseti method continues to be the cornerstone of treatment, even in older children, though it may require prolonged casting, modified techniques, or adjunctive minor surgical procedures. Community-based screening, task-shifting to trained non-specialist healthcare workers, parental education, and integration of clubfoot care into existing maternal and child health programs are essential strategies to address delayed presentation. Additionally, strengthening primary healthcare systems and improving referral pathways can facilitate earlier identification and timely intervention. This article reviews the key challenges associated with delayed presentation of clubfoot in rural settings and outlines practical, cost-effective management strategies suitable for low-resource environments. Emphasis is placed on evidence-based conservative care, health system strengthening, and community engagement to improve functional outcomes and reduce the long-term burden of untreated clubfoot. Addressing these issues is essential for achieving equitable musculoskeletal health care and preventing avoidable disability among affected children in rural populations.